Vaccination Coverage of 2-Year-Old Children -- United States, 1992-
1993

The principal goal of the Childhood Immunization Initiative
(CII) is to increase, by 1996, vaccination levels for 2-year-old
children to at least 90% for the most critical doses in the
vaccination series (i.e., one dose of measles-mumps-rubella vaccine
{MMR} and at least three doses each of diphtheria and tetanus
toxoids and pertussis vaccine {DTP}, oral poliovirus vaccine {OPV},
and Haemophilus influenzae type b vaccine {Hib}) and to at least
70% for at least three doses of hepatitis B vaccine (Hep B) (1).
Since 1991, annual national estimates of vaccination coverage
levels of preschool-aged children have been available through the
National Health Interview Survey (NHIS) conducted by CDC (2,3).
This report presents vaccination coverage levels of children aged
19-35 months for 1992 and provisional estimates of vaccination
coverage for the combined first and second quarters of 1993
(Table_1).
Vaccination coverage increased for three vaccines from 1992 to
1993: for three or more doses of Hib, from 28.0% to 49.9% (p less
than 0.05); for three or more doses of poliomyelitis vaccine, from
72.4% to 78.4% (p less than 0.05); and for three or more doses of
DTP/ diphtheria and tetanus toxoids (DT), from 83.0% to 87.2% (p
greater than 0.05). Coverage with measles-containing vaccine
decreased from 82.5% to 80.8% (p greater than 0.05). Among 19-
35-month-olds, 12.7% had received three or more doses of Hep B.
From 1992 to 1993, the proportion of children who had received a
combined series of four or more doses of DTP/DT, three or more
doses of polio vaccine, and one dose of MMR increased from 55.3% to
64.8% (p less than 0.05), primarily because of increased coverage
with the fourth DTP/DT dose (from 59.0% to 71.1% {p less than
0.05}).

Editorial Note

Editorial Note: In 1993, processing of the NHIS was modified to
produce national vaccination coverage estimates for each quarter.
The findings in this report represent the first provisional
quarterly estimates and indicate substantial progress in efforts to
attain the 1996 antigen-specific vaccination goals for DTP and
polio vaccine. However, coverage with measles-containing vaccines
has not improved since 1991, when 82.0% of 2-year-old children were
reported to be vaccinated.
Although the coverage levels for Hib and hepatitis B remain
suboptimal, the levels described in this report may underestimate
coverage because many children were born before the recommendations
for universal infant vaccination that were promulgated in October
1990 (4) and November 1991 (5). Less than 1% of 19-35-month-old
children surveyed during January-June 1993 were born after
recommendations for universal infant vaccination against hepatitis
B went into effect. Similarly, only approximately two thirds of the
children aged 19-35 months included in this survey were born after
October 1990 -- when Hib was approved for infants.
Provisional results from NHIS for the first two quarters of 1993
indicate that the combined efforts of public and private
health-care providers at local, state, and national levels have
facilitated progress toward both the 1996 CII goal and the year
2000 national health objective to increase vaccination levels for
2-year-olds to 90% (objective 20.11) for the complete series of
recommended vaccine doses against all nine diseases (i.e., four or
more doses of DTP, three or more doses of OPV, three or more doses
of Hib, one dose of MMR, and three or more doses of Hep B) (6).
However, based on the reported 1993 coverage levels, approximately
1.25 million children require at least one dose of OPV, and 1.12
million require a dose of measles-containing vaccine; approximately
740,000 children have not received at least three doses of DTP/DT.
These findings emphasize the need for public and private
health-care providers and local, state, and national public health
officials to collaborate on implementation of the CII to achieve
higher levels of vaccination coverage among 2-year-olds.

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